Moda Health HCC Coding Specialist in Portland, Oregon

HCC Coding Specialist

Job Title

HCC Coding Specialist

Duration

Open Until Filled

Location

Portland,

OR

97204

Other Location

Underwriting/Actuarial; Job Class: 109

Description

Let’s do great things, together

Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.Moda Health is seeking an HCC Coding Specialist to join our Underwriting/Actuarial team. This position will audit vendor and internal risk adjustments coding to ensure accuracy and identify and mitigate any risks. The coder will validate provider, vendor, and internal diagnosis coding for accuracy by reviewing and analyzing samples of coding and claims extract compared to actual medical records; and will review and identify trends in coding discrepancies and notify applicable department for potential training and education. As needed, this position will prepare and present educational material on risk score issues to internal staff, related parties, and provider offices.Primary Functions:

  • Performing chart reviews, and coding for HCC coding to determine the completeness of the HCC data documentation/coding.

  • Become and/or maintain expert knowledge of HCC coding for both Commercial ACA and Medicare Advantage, including regulatory processes/rules.

  • Assist in the development of action plans and training material that may include workflows, education, policies, and system enhancement to promote enhanced learning and compliance.

  • Performs other duties as assigned.

Are you ready to be a betterist?

If you’re ready to make a difference that matters, we want to hear from you. Because it’s time to discover what’s possible.

Together, we can be more. We can be better.

Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law.

Required Skills

  1. High School diploma or GED required, Bachelor’s degree preferred.

  2. Current Coding Certification (CPC, CCA, CCS) through AHIMA, AAPC or other official coding organization.

  3. 2+ years’ experience in medical coding, risk adjustment coding or Hierarchical Condition Category (HCC) coding experience in the healthcare industry; or related experience.

  4. Excellent organizational skills required.

  5. Strong verbal, written and interpersonal communication skills.

  6. Microsoft Excel, Word, and PowerPoint skills.

  7. Ability to project a professional image and maintain complete confidentiality.